Abstract

<i>Background : </i>
Primary health care, which was the domain of the nursing profession, was popularised by the introduction of free health
services by the South African legislature. In addition, the district health system was developed with the aim of keeping
people healthy by creating small management systems adapted to cater for local needs. These measures increased public
access to healthcare centres, leading to an increased workload at primary health level. The government, being a large
organisation, relies on groups that include doctors and nurses to accomplish its goals, and the effectiveness of these groups
plays a major role in determining the effectiveness of the overall organization. "The nurse has an ethical responsibility in
the interest of the welfare of her patient to be a loyal and competent colleague to the doctor. The nurse and the doctor must
be able to rely on each other. Mutual respect is vital." Nurses have dependent, independent and interdependent roles in
their interaction with doctors, and both professions should embrace the Patient's Rights Charter, which requires a good
standard of practice and care of patients. International journals have published numerous letters citing doctor-nurse
disagreements in their interactions. Historically, the doctor-nurse relationship is an unequal one characterised by the
dominance of the doctor, with nurses assuming a position of lower status and dependence on physicians. One qualitative
study showed that nurses perceive the quality of communication with doctors as being poor. Lack of teamwork in the
relationship resulted from different expectations and a confusion of roles. Both professions have however demonstrated a
willingness to promote teamwork in hospitals. A journal review on interventions to promote collaboration between nurses
and doctors showed positive gains once collaboration was embraced.
<br><I>Method : </I>
This was a descriptive qualitative study in which the experiences of Kwa-Nobuhle general practitioners and professional
nurses were explored. An equal number of nurses and doctors (five each) were purposefully selected, for the free-attitude
interviews used for data collection. All interviews were analysed using the thematic analysis method. Themes were integrated
into a single model.
<br><I>Results : </I>
Majority of respondents experienced a relatively good relationship. The positive factors were balanced by negative experiences
by almost all respondents. The positives were personal growth, efficiency at work, opportunity for education and learning
at the primary healthcare level. The negatives were doctors' inconsistent clinic visits, role confusion (with doctors being
confused with policymakers), dominance of the doctor in the relationship, and lack of doctor-nurse forums for communication,
with subsequent suspicion and tension. The impact of the conflicts was neutralised by the track record of the relationship
and the behaviour of the participants towards each other.
<br><I>Conclusion : </I>
This study showed congruence with other studies, where the doctor-nurse relationship was influenced by a power differential,
collaboration, role confusion, impact of the respondents' competence, the significance of recognising the nurses' hierarchy
and continuity of the care they provide at the primary health level.
<br>Maximum variation, strict admission criteria and data validation through a member check addressed issues of bias in this
study. The exploration of relationships is a sensitive issue and a different methodology may produce different results. The
environment where this research was conducted may differ from others, leading to discrepancies in findings. Future research
could further focus on team building and the essential elements to sustain the doctor-nurse-patient team.